PRE 2010 DOCSDate • �• ♦• 1 w r ..
a: '"e'�►� Builder ; . .. .. .. .
Owner „ . '
,I
Address.,..... Addressp .. ....
..
..,LOCATION"OF BUILDING
No Si teat ,rt of Lot..................... .
Lot .. lrF. Block Addition or Sub -Di . on '.� fes.. A .. '
• f:•
Corner Lot . .. Inside Lot .... Setback- 7.� �Q........... .
r Sideyard .. .
To be Used as:
'I 4
Type of Constructi n
in consideratio
the proposed work
ordinances of the v
In consideratioi
the express conditi(
done in, around ahi
Fridley, Minnes6ta
in the village Iimiti
ordinances.
This permit
sewer or water.
DESCRIPTION. OF -BUILDING
M..�. S . Ft/..
s� J
Front n Depth Height q Cu. Ft....... .
F,�ant . Depth � r00
�. Height .� s .. Sq. Ft. 'Cu. � .Cu. >+ t• .. .:... .
_'Est. Cost�'.•� p } . To be Completedlip
...
i
i of the issuance to meof a permit to construct the building described above, I agree to do
In accordance with the description above set forth and in compliance with all provisions of
Mage of Fridley.
...
i of the; payment of a fee of $.. ; permit is hereby granted to
. to construct the building or addition as described above. This' permit is granted' ;upon
n that the person to whom it is granted and his agents, employees and workmen, in all work
I upon said building, or any part thereof, shall conform in all respects to the ordinances of
regarding location, _construction, alteration, maintenance, repair and moving of buildings with -
and this permit may be revoked at any time upon violation of any of the provisions of said
•'�;`� ate, Building Inspector
does not cover the construction, Installation or alteration for wiring, plumbing, gas heating,
Be sure to see the Building Inspector for separate permits for these Items.
SUBJECT
PER�27
City of Fridley
17
AT THE TOP OF THE TWINS
BUILDING PERMIT
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC
NUMBERREV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910415
9/22/98
JOB ADDRESS 6720 4th St NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
6
2
Rice Creek Terrace Plat 3
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Edith Martin
571-3777
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Solomon & Sons 12211 Olive St NW Coon Rapids 55448
754-5875 20055664
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION C REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house garage (25SQ) Tear -off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING. HEATING.
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT
CU FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
ISTALLS
GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$ 2,142.00
$1.07
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
Fire SC $2.14
S U TION OR THE PERFORMANCE OF CONSTRUCTION$74.75
0
Y
PLAN CHECK FEE
TOTAL FEE
G
License SC $5.00
$82.96
SIGNATURE OF CON'RAGTOR OR A UTHORIZED AGENT IDATEI
WHEN PROPEZIVALI ATED THIS IS YOUR PERMIT
BL G -NSp
OAIt
S-GNATURE OF OWNER. -F OWNER BUILDER- IDATEI
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION /
ConstructionAddress: 6 ��
Legal Description:
Owner Name & Address: 9we Cf� `l�2-icQL.%v Tel. # ,57?/" 777`7
Contractor: ` (� /()/)l wi e N� MN LICENSE # sY66 y
Address:f�-/` Q&e- .-dt, &W) Tel. #�5�/ 5� 71 -
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF E%IPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Len th Width Hgt/Ground Sq. Ft.
OTHER:®4P �(r� �� �r/fe- f ). V (T-_0
Construction Type:_9—e/to c) 1 Estimated Cost: $�`��
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $
DATE: P-op� j9:i" APPLICANT.0 Tel. #'75"I -ST 7T
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ foo
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1000 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
i
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
Building
BUILDING
Permit No.. 6
Inspections
RESIDENTIAL APPLICATION
Received By -
y763-572-3604
763 -572-3604
CITY OF FRIDLEY
nate Rec'd:
DATE -200-7 YOUR E-MAIL ADDRESS
SITE ADDREss (6-72C2 Vo -51-,VF- 1=f; j 1a, /11A/
THIS APPLICANT IS:
KOWNER ❑CONTRACTOR
PROPERTY OWNER/
NAME: C_ briS f-cn118 C DA A S
TENANT
ADDRESS: 61 TO 4-%- ST &-a CITY
STATE,ivZIP sX -13 Z
PHONE: l a- C7O S– 3 8►0 8
CONTRACTOR
NAME:
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: CITY
STATE—ZIP
WITH APPLICATION
pH0 FAX
PROPERTY TYPE
LE FAMI W CONSTRUCTION SIZE �iipbLQf
TWO FAMILY/NEW CONSTRUCTION STO
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING J?es.'dg W C
- 01' J
DESCRIBE WORK BEING DONE: 0-51-8 onj houSi
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT S . Ft.
❑ HOUSE ONLY
NUMBER OFWUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GES13ATTACHED
GARAGE
I.
Existing Floor Plan
PRO SIZE:
❑ DETACHED GARAGE
2.
Proposed floor plan
PROPOSED
3.
List of structural members to be used
SEDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soffit
ADDITIONS. & PORCHES SUBMIT:
❑ AluminuD
' 1
❑ Trim
1.
Site Plan/Survey showing the existing struchues
C Zft9*F - bDot f
❑ Fascia
and proposed project
T�OtI_,_er
WINDOWS
2.
Two sets of construction plans
IN EM12NG OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
3.
Energy Calculations
OR FOROPENINGS-DESCRIBE SIZE OF
OPENING C GES &
TYPE OF WINDO INSTALLED NUMBER OF•WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 97 U.B.0 FEE
TOTAL JOB VALUATION ��OCCUPANCY TYPE
Permit Fee $ Q117. �S See Back Page for Fee Schedule
Plan Review $ 65% of Building Permit Fee
Fire Surcharge $ .001 times the total job valuation
Surcharge $ .0005 x Permit Valuation Minimum $.50
License Surcharge $ $5.00 (State Licensed Residential Contractors)
SAC Charge $ $1675 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow $ ft + 6 ft = ft x $21 =$
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( }
Total Due $ f') Make checks payable to: City of Fridley Attach Stipulations
THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work whic r qu/�ir�es re/v�iew�and approval of plans. n
,/y' S t� r hri,j / �(( als DATE �� ^ O
SIGNATURE OF APPLICANT PRINT NAME